Dose to the contralateral breast due to primary breast irradiation

Abstract

The radiation dose received by the contralateral breast during primary breast irradiation is of concern because breast tissue is subject to cancer induction from low to moderate doses of radiation. In this paper the dose to the opposite breast has been studied in detail for common breast treatment techniques. Measurements have been made on 16 patients, a water phantom, a polystyrene phantom with cork inserts to simulate lung tissue, and a body-shaped phantom with wax breasts. Thermoluminescent dosimeters (TLD), ion chambers, diodes, and film have been used in the various configurations. The patient measurements have shown that there is a wide variation in the opposite breast dose received by patients, even when all are treated with, for example, tangential fields alone. Addition of more radiation fields, such as supraclavicular/axillary and internal mammary fields, may increase the dose to the opposite breast for a particular patient. Variations in the details of the technique such as what wedges are used, the use of blocks, and the orientation of the field edges are all important to the final dose received by the patient's contralateral breast. With the phantom measurements, it has been possible to determine the contributions to the opposite breast dose from each of the relevant factors. This makes it possible to explain the wide variation in patient dose measurements, and to make some relatively simple recommendations that will allow the reduction of the dose to the opposite breast from several hundred cGy to about 50 cGy for a typical treatment course dose of 5000 cGy.